Still covering up

Almost ten years ago I wrote about Julie Bailey, a whistle-blower who was relentlessly persecuted and harassed after she exposed sub-standard care and unnecessary deaths at Mid Staffordshire NHS Trust.

Supposedly, since then whistle-blowers have received stronger protection and support and can expose malpractice without being treated as the guilty party.

Well, that's the theory. In practice it seems that little has changed and whistle-blowers can still be told to shut up and stop making trouble.

The recent case of Lucy Letby, the nurse who murdered seven babies at the Countess of Chester Hospital and could easily have murdered several more, showed that pointing out wrong-doing can still be seen as a hostile act rather than a necessary warning.

Two medical consultants, Dr Stephen Brearey and Dr Ravi Jayaram, both raised concerns about unexplained infant deaths at the hospital as early as July 2015.

But both were rebuffed constantly by hospital managers. Dr Jayaram was told "not to make a fuss". It wasn't until June 2016, after repeated complaints, that Letby was finally removed from her clinical duties.

Of course it's obvious why whistle-blowers are so badly treated. The members of staff who are at fault are desperate not to lose their good reputation, and in this case the good reputation of the hospital. So they turn on the whistle-blower to save their own skin and they refuse to admit to any mistakes.

There needs to be a new attitude that says it's okay to make mistakes, we all make them, and that admitting mistakes as soon as possible is a positive move and not a negative one. Confessing promptly to mistakes shouldn't damage your reputation, it should enhance it.

How many dangerous mistakes are still being covered up?

Pic: Lucy Letby

.......................................................................................

No, I haven't died. Jenny and I have been in Liverpool for the Art Biennial, and to see two old friends in Chester. We had a great time and saw loads of wonderful artworks.

An air of authority

Strange things, uniforms. Good in some ways, not so good in others. Some people like wearing them, some don't. What difference would it make if they were abolished tomorrow?

I was fortunate to do jobs that didn't require a uniform - things like bookselling, journalism, admin, charity work. I've only owned one suit in my entire life, when I was a journalist, and I can't remember now if it was obligatory or I just wanted to be a snappy dresser.

Both my schools had uniforms, and I can't remember having any opinion of them one way or the other, apart from feeling smarter than the other kids in the street. I didn't yearn for something more fashionable, as I was never interested in fashion.

I suppose the advantage of uniforms is that they can give you an air of authority and expertise. And of course you don't have to agonise over what you're going to wear today. The decision has been made for you.

The disadvantage is that some people are hostile to anyone in a uniform, equating a uniform with officialdom, bossiness and condescension. They'll have a go at paramedics, nurses, police officers or even cabin crew.

I'm not keen on those workplace dress codes that are effectively uniforms - short skirts, high heels and make-up for women, or suits, plain shirts and ties for men. The idea is that they look more "professional" but personally I couldn't care less if a woman's skirt is long or short, I just want to know if they're good at the job.

Supposedly a lot of men go weak at the knees at the sight of a nurse's uniform. I can't say I've ever had that reaction. Dazzling intelligence is far more likely to put me in a spin. Or dazzling achievement. Or just a zest for life. With or without a uniform.

A nurse's story

When I was in hospital for my prostate operation in 2017, I was aware of how busy the nurses were, scurrying from one patient to another checking their vital signs, keeping an eye on whatever equipment they were plugged into, giving them help of one kind or another. But I didn't know the half of it.

A book by the former nurse Christie Watson* reveals the reality of a nurse's job and just how demanding and meticulous and scary and messy it can be. I can only admire those resilient souls who take on such a difficult job and do it so well.

• They have to clean up shit, piss, vomit, diarrhoea, blood and all sorts of foul liquids that a sick patient produces.
• They have to give patients the right medicine, at the right dosage, in the right way, at the right time. One tiny slip can lead to a major emergency or even death.
• They may work very long shifts (often night shifts) of 12 hours or more with barely time to eat or use the toilet, such is the relentless pressure.
• They have to be familiar with hundreds of common or less common medical conditions and how each is treated.
• They need to be alert to the smallest change in a patient's condition that means urgent action is needed.

It's not a job for dawdlers or the faint-hearted. They do it for the satisfaction of helping very sick people become fit and healthy again, and seeing pain and terror and misery replaced by smiling, grateful faces. They want to do a job that really means something, not just a pen-pushing office job.

Quite a few nurses don't last the course. Sooner or late they realise they're not up to the unremitting demands and responsibilities of the job and they quit.

Jenny was a nurse for a while. My sister Heather was a nurse for a while. My niece Lucy has just qualified as a Registered Nurse and I applaud her for it. I think of all the pain and suffering she will relieve and the many hundreds of lives she will save.

*The Language of Kindness: A Nurse's Story by Christie Watson

Imperfect flesh

I'm surprised that so many people - mainly women but also men - find it so hard to expose their body to doctors and nurses. People have so much inhibition, shame and self-loathing about what they look like and how they might be judged.

I've never had any problem showing my body to health professionals. I'm sure they couldn't care less what I look like - whether I'm fat or old or ugly or bald or whatever. They're just doing a job and what the patient looks like is neither here nor there. I'm sure they've seen every possible variety of human oddities and one more won't faze them. They don't expect anyone to be "normal" as they know we come in all shapes and sizes.

But there are many people who're completely thrown by the idea of exposing their imperfect flesh for examination. They would rather ignore worrying symptoms than face a doctor's scrutiny.

I read that many women avoid smear tests because they're embarrassed by the look and smell of their pubic areas. Or they worry that they're wearing the wrong sort of underwear or clothing. Or they feel awkward about their body shape. So they invent all sorts of excuses for not getting tested.

I guess some men are equally embarrassed about showing their bodies, though we don't hear much about them. The guys who're mortified by their beer bellies, general flabbiness, or rampant hairiness. I'm sure they're out there.

I'd like to confirm my human frailty and vulnerability by telling you how I squirm and cringe as the doctor examines me, but it wouldn't be true. I honestly don't give a toss what she thinks of my spreading bum or misshapen toenails or weedy chest. I just want to know if there's anything unhealthy going on and get it treated. That's my only concern.

Distressed nurses

The vast majority of NHS nurses say they sometimes or always leave work in distress because they can't give patients the dignity and quality of care they would like to give.

They say they are hampered not just by lack of time and staff shortages but by management failures that mean patients have to put up with embarrassing and dehumanising stays.

Patients are often denied single-sex wards, adequate washing and toilet facilities, help with eating and complete privacy when required.

In a Royal College of Nursing poll, 81% said there times when they left work feeling patients had been let down. Some 86% said dignity should be a higher priority.

Surely such issues as appropriate privacy and being able to wash properly are so basic they should be automatically guaranteed without nurses having to complain and make do and apologise to angry patients.

If we wouldn't accept these shortcomings in our own homes, why are they considered acceptable in hospitals, particularly when they just cause further stress to patients already suffering the stress of being hospitalised?

The feeble assurances by government ministers that patients' dignity is a top priority are not convincing when the everday reality is that this is clearly not the case and there is no sign of any radical improvements.

As in so many areas, the government is again fanatically penny-pinching with a vital public service that needs to be urgently upgraded.

There are shedloads of cash available for a new generation of nuclear missiles and a hugely ambitious ID card project, but the tottering NHS is apparently not so deserving. So nurses are left frustrated and despairing.